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Approximately 60% of patients aged 65+ are at risk of malnutrition, or their situation worsening, whilst in hospital (Age Concern, 2006). We report the results of an ethnographic study of the meal services at 5 hospital sites across two regional locations, focusing on older patients admitted for stroke, fractured neck of femur or with dementia. Data were collected through: observation of meal services from storeroom to patient; semi-structured interviews with NHS staff (n=47) and stakeholders (n=7); a focus group with former patients and carers (n=5); and participant-observation in two workshops designed to generate ‘solutions’ to malnutrition. Normalization Process Theory (NPT) informed the analysis. A range of factors contributing to malnutrition were identified. These varied from broad organisational and structural issues, to patterns of work and priorities on individual wards. Centrally ‘food-work’ and the interpersonal care of the patient were regarded as fundamental to adequate nutrition; however these activities were conceptualised differently across organisational, disciplinary and policy contexts. Junior staff explained the tacit, technical and nuanced nature of interpersonal work, yet attributed their own proficiency to “common sense”. As staff increased in technical knowledge and status, so their accounts of food-work became focussed on resources, structures and procedures operating beyond the ‘30-40cms’ between patient and plate. We suggest that whilst food-work is recognised as being fundamental to adequate nutrition for older patients, investment in this work is overlooked by policymakers, clinicians and researchers